APPLICATION TO FILE SMALL CLAIM / COMMERCIAL CLAIM

CITY COURT of __________________   :   COUNTY OF ______________________

FILING FEE:     Money Order, Certified Bank Checks or Cash only

Type of Claim:                                                 Filing Fee:                                                            (Check one)

Small Claim                                                     $15.00 - Claim of $1,000 or less                              _____
(Individual suing individual or company)            $20.00 - Claim exceeding $1,000 to $5,000            _____

Commercial Claim                                            $25.00 + $5.27 postage for each defendant             _____
(Company suing company or individual)
(Required forms - Certificate of Authority and Certification on Filing Limits)

Consumer Transaction                                       $25.00 + $5.27 postage for each defendant            _____
(Company suing individual in a Consumer Transaction case)
(Required forms - Certification of Authority, Certification on Filing Limits and Certification of Demand Letter sent)

Counterclaim                                                      $  5.00 + $ .47 postage                                         _____

Date:     ___________________________________

Name of Claimant (include all necessary parties):
______________________________________________________________________________________
______________________________________________________________________________________

Address (if commercial claim, give Principal Office Address)
______________________________________________________________________________________
______________________________________________________________________________________

Telephone no.:____________________________________________________________________________
                                         (Work)                                                         (Home)
                                                                                      against
Name of Defendant (include all necessary parties):
______________________________________________________________________________________
           (if a business -provide business name AND name of  individual who owns/operates/manages business)
_______________________________________________________________________________________________

Address ______________________________________________________________________________________

(Home or Business./Place of Employment must be within the County - except for counterclaims)
Telephone no._________________________________________________________________________________

Amount of Claim $__________________________
                                  (Do not include filing fee)
Nature of Claim to include all pertinent information including descriptions, dates, addresses, etc.
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________

DATE  _____________________________________                                                                                         SIGNATURE OF PERSON__________________________________________________________
FILING CLAIM_______________________________________________